Corneal Crosslinking Tied to Drop in Other Keratoconus Surgeries

Corneal crosslinking, a specialized procedure for progressive keratoconus, was FDA-approved for patients 14 years and up. It is considered the only treatment that halts keratoconus progression. Photo: Lily Arendt, OD. Click image to enlarge. Corneal crosslinking (CXL) was associated with a major decline in corneal transplant procedures such as penetrating keratoplasty (PK) and anterior/lamellar keratoplasty (ALK) for keratoconus after its FDA approval, according to a study published in Cornea.Researchers in California analyzed electronic health record data from the TriNetX medical database to determine how the 2016 approval of CXL affected surgical treatment patterns in patients with keratoconus. They examined the data of 18,960 patients who had recorded keratoconus diagnoses before and after April 18, 2016. Patients were divided into cohort groups based on whether they received PK or ALK surgery and whether they received it before or after the CXL approval date.The patient cohorts consisted of about half of each group’s patients identified as white and over half (55.83% and 61.59% before surgery, 60.02% and 60.04% after surgery) being male. The study found that “the incidence of PK procedures before April 18, 2016, was notably high at 9.75% but dropped markedly to 3.88% after the introduction of CXL,” leading to a 5.87% risk reduction and “over 2 and a half times more likely to undergo PK before the availability of CXL.” ALK rates experienced a similar decline from 3.88% before approval to 1.16% after it.Long-term analysis of patients who received CXL showed that only 0.79% of patients “received any keratoplasty procedure (PK or ALK) after CXL,” as noted by the authors in their paper. Patients with unstable keratoconus were also about 5.6 times more likely to undergo CXL.The authors concluded that FDA approval of CXL “was associated with a marked reduction in PK and ALK procedures among patients with keratoconus in the United States,” indicating a widespread acceptance and implementation of CXL in practice. That point was backed by other cited studies, which found that “approximately 90% of patients with keratoconus have shown stable corneal topography a decade after undergoing crosslinking.” However, they acknowledged that the study was limited by some aspects of its design, including that it only included adult patients and that, because of CXL only being widely approved of 10 years ago, there may not be enough long-term data to justify the benefits of CXL over other procedures.Click here for the journal source. Gad El Sayed M, Patel R, Hwang F. TriNetX analysis of surgical treatment patterns of keratoconus before and after the approval of corneal crosslinking in the United States. May 26, 2026. [Epub ahead of print].  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.